New NHS draft guidelines look set to encourage more women to give birth at
home, but medical intervention must not be sidelined

When we talk of great medical discoveries and inventions, a few stand out: Aspirin (1829), general anaesthesia (1846), penicillin (1928), the polio vaccine (1952). Rarely, though, does anyone mentions forceps. Yet in the early 1730s, when clergyman Stephen Hale designed this glorified set of tweezers to help doctors extract bladder stones, he made possible a development that all of us should profoundly, frequently praise: medical intervention at birth.

From that decade on, in the reign of George II, deaths in childbirth (of both mother and child) began to fall dramatically. In the 18th century, one in a hundred women died in, or as a result of childbirth. Today in the UK, a woman’s risk of dying during or following pregnancy is one in 12,500. Compare that with countries where medical help is scarce, such as those in Sub-Saharan Africa, where one in 31 mothers will die. In the UK, we lose one in 250 babies either at birth or before their first birthday. In Somalia, infant mortality is just over one in 10.

Of course, surgical intervention in the delivery room is not the whole story in combating maternal/neonatal mortality. In the past 300 years we have got better at birthing thanks to numerous other advances, including sterile environments, pain-relieving epidurals, foetal monitoring, ultrasound scans, antibiotics, and high-quality clinical care delivered by midwives, nurses and obstetricians. No one would want to turn back the clock to the days when every woman who got pregnant faced agonising pain, fear, and the possibility of death at the onset of labour. Or do we?

Victoria Lambert and daughter Rowena

In my view the NHS has, this week, taken a step back into that grim era with the announcement that home births are to become the first choice whenever possible, including for some first-time mothers.

As the Telegraph reported, Nice (the National Institute for Clinical Excellence) has reversed its position on the issue. Just two years ago the guidance was to offer elective

C-sections on demand and advise “caution” over home births. Now, new draft guidelines that have been put out for consultation, suggest mothers-to-be are denied a hospital delivery unless there is a high risk of complications (such as diabetes or pre-eclampsia). First-time mothers will be advised that it is just as safe having a baby in a small midwife-led unit as it is on the labour ward with a doctor supervising; experienced mothers, meanwhile, will be told that a home birth is as safe as in a hospital – and far more pleasant.

Pleasant surroundings weren’t my main concern in the final months of my pregnancy in 2004-5. Aged 39 and with a chequered gynaecological history involving multiple miscarriages, I would never have been classified as “low risk”. But there were still numerous efforts made by what I will generously describe as well-meaning midwives to encourage me to have some sort of active birth involving few drugs and plenty of shouting, possibly a birthing pool, some scented candles and a CD of mood music to play as my child entered the world.

When one midwife went so far as to warn me that I could die if I opted to give birth in a hospital, I turned to my consultant gynaecologist. She offered me an elective Caesarean immediately. “You’ve been through enough,” she said kindly. A highly experienced doctor and mother of two – a veteran of thousands of pregnancies and deliveries -thought that a C-section performed at a specified time was the safest and, yes, easiest option going for me.

Even now, it is difficult for me to fathom how anyone could have thought differently given my history. After all, there is only one endgame in town for childbirth – safe delivery for mother and child. So who cares how that is achieved?

The bean counters, I suppose. The new Nice guidelines may have drawn inspiration from a report in the British Medical Journal published in April 2012 on research conducted by the University of Oxford. It found that the average cost for a home birth is £1,066, with midwife-led births costing £1,450 and hospital births £1,631. Home births, it concluded, are the most cost-effective.

But given that the UK is experiencing its highest birth rate in 40 years combined with a drastic shortage of midwives – Unison estimates that Britain needs another 5,000 – one must wonder if saving cash is a priority when weighed against maternal and infant lives.

Another influence on Nice will have been the controversial 2011 Birthplace Study, which reported that, for low-risk women having their second or third child, a home birth or midwife-led unit was as safe as a hospital. Leading doctors lined up at the time to point out that half of the women in the study who gave birth in midwife-led units or at home were subsequently transferred to hospital, and that groups of women in the study were selected to give a favourable impression of midwife-led units.

Dr Antony Falconer, then president of the Royal College of Obstetricians and Gynaecologists, wrote, with colleagues, to the BMJ to highlight the flawed research, including the alarming fact that 20 of the 32 neonatal deaths in the study occurred in low-risk women giving birth at home or in free-standing midwife-led units.

Despite this, it seems likely that we will see a rise in home births – and an unwelcome boost to the strident, placard-waving natural-childbirth mavens who devote their time petitioning NHS directors and nagging NCT groups.

These are the advocates of home birthing who, with minimal evidence and maximum anecdote – the polar opposite of Nice’s working practices, incidentally – ignore the fact that not every woman is able – or just as importantly, wants – to give birth at home without the option at least of medical back-up should it be needed.

This crusading sisterhood insists it’s natural to have a child at home and that until recently it was what the vast majority of women did. By ''recently’’, read 1948. For as soon as the National Health Service was established and the option of a hospital birth was a reality, mums-to-be jettisoned the chance to bleed to death in front of the gas fire in the parlour, in favour of clean sheets (washed by someone else), meals on a tray, and a man in a white coat with a stethoscope around his neck.

What infuriates me most about these home-birth bullies is how they bask – years after the event – in their achievement. It’s all about their bravery, their stamina, their levels of physical fitness, even their (alleged) orgasms at the moment of delivery. Please! Women who don’t give birth this way (97.5 per cent, or 711,750 of the 730,000 women who go into labour in England and Wales each year) are airily dismissed by them as “failures”.

Well, I’d rather be perceived a failure than denied a choice. Choice in how to give birth and where is what matters most. And it’s what most gynaecologists, midwives and experienced mothers advocate, too. A home birth should be just as attainable and safe as an elective C-section. I wouldn’t want Nice guidance swung the other way either. After all, I was the result of a safe home birth a few decades ago.

My own labour started spontaneously at 33 weeks – before even my course of NHS antenatal classes had begun – and I was lucky that my consultant and the hospital had been so supportive about a C-section from the start. It meant my fears were focused only on the outcome and not on the procedure, even though it was carried out as an emergency rather than a planned one.

I felt blessed to have so many doctors, nurses and midwives lining up to help me through a terrifying time. More important than my feelings, however, was the deft surgical skill that saw my premature breech baby daughter Rowena brought into the world safely and then me sutured up – quite brilliantly – too. For that outcome, I would have tap-danced or sung show tunes, lost a finger or my entire bank balance. Some things are far more important than doing it naturally in “pleasant” surroundings, whatever the home-birth bullies say.